| NPI | 1790174761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95001904) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95001904) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95001904) | |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2025-02-13 |